Risk factors and management of obstetric perineal injury

Perineal injury sustained during childbirth is a major aetiological factor in the development of perineal pain, sexual dysfunction, prolapse and disturbance in bowel and bladder function. Preferential use of the vacuum extractor, restricting the use of episiotomy, repair of anal sphincter rupture by a trained doctor and selective Caesarean section in these women are some factors that can be beneficial in preventing complications. More focused training of midwives and doctors in perineal and anal sphincter anatomy and repair is clearly needed to minimise the morbidity associated with inadequate repair and missed tears. Future research needs to address the ways to predict and minimise severe perineal injury, and the management of subsequent pregnancy following anal sphincter injury.